title: Causes of dysphagia in a tertiary-care swallowing center.
abstract: OBJECTIVE
  Dysphagia can be caused by a myriad of disease processes, and it has significant impacts on patients' quality of life, life expectancy, and economic burden. To date, the most common causes of dysphagia in outpatient tertiary-care swallowing centers are unknown. We undertook this study to determine these prevalences. We also describe the diagnostic techniques utilized to establish the diagnosis.
  
  
  METHODS
  The electronic charts of 100 consecutive patients who presented to an outpatient tertiary-care university swallowing center between January 2010 and April 2011 were retrospectively reviewed. Information regarding patient demographics, validated symptom surveys, diagnostic workups, and ultimate diagnoses was abstracted and tabulated into a central database. Descriptive statistics were used to evaluate the association between patient symptoms and diagnoses.
  
  
  RESULTS
  The mean age of the entire cohort was 62 +/- 13.5 years, and 58% of the cohort was male. The most common identified causes of dysphagia were reflux (27%), postirradiation dysphagia (14%), and cricopharyngeus muscle dysfunction (11%). In 13% of cases, the cause of dysphagia was undetermined. The diagnostic tests utilized included flexible laryngoscopy (71%; 17% with endoscopic swallow evaluation), modified barium swallow study (45%), esophagoscopy (35%), barium esophagography (21%), manometry (10%), and ambulatory pH testing (2%).
  
  
  CONCLUSIONS
  The most common causes of dysphagia in a tertiary-care swallowing center are reflux, postirradiation dysphagia, and cricopharyngeus muscle dysfunction. A precise cause for the symptom could not be identified in 13% of our cohort. Endoscopic visualization (laryngoscopy, flexible endoscopic evaluation of swallowing, and transnasal esophagoscopy) and fluoroscopic swallow studies were the investigations most often utilized. These techniques can be used to arrive at a diagnosis in 80% of cases.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Hoy
authors.forename: Amanda
authors.initials: A
authors.lastname: Domer
authors.forename: Emily K
authors.initials: EK
authors.lastname: Plowman
authors.forename: Randall
authors.initials: R
authors.lastname: Loch
authors.forename: Peter
authors.initials: P
authors.lastname: Belafsky
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D012189:Retrospective Studies; D062606:Tertiary Care Centers